Lifetime exposure to violence and early cardiometabolic risk factors in a healthy Swedish cohort

Introduction Violence exposure has been associated with cardiovascular disease. Less is known about underlying mechanisms, including early cardiometabolic risk factors, and possible sex differences of such associations. Methods We used data from the Swedish LifeGene study on 23,215 males and females, aged 18-50 years. At baseline (2009-1016) participants answered the Life Stressor Checklist-Revised alongside questions on medical diagnoses of hypertension, diabetes, dyslipidemia and smoking history. At a clinical visit, blood pressure, BMI, glycated hemoglobin (HbA1c), total cholesterol, ApoB/ApoA1 ratio, and high-sensitivity C-Reactive Protein (hs-CRP) were measured. Modified Poisson and linear regression were used to test the association between violence and cardiometabolic risk factors. Results At mean age 33±8 years, lifetime exposure to violence was reported by 23% of females and 15% of males. Those exposed to violence were more likely to smoke (PR 1.86, CI: 1.66–2.07) and report a diagnosis of hypertension (PR 1.39, CI: 1.18-1.64). While no differences were observed in measured systolic blood pressure (B -0.34, CI: -0.70, 0.02), HbA1c (B 0.06, CI: - 0.08, 0.20) or total cholesterol (B -0.01, CI: -0.04, 0.02), both males and females exposed to violence had higher BMI (B 0.51, CI: 0.39–0.63) and hs-CRP (B 0.11, CI: 0.06–0.16), after adjustment. Violence in childhood, as opposed to adulthood, and exposure to both sexual and physical violence, as opposed to either type, was more strongly associated with hs-CRP and BMI. Discussion In a young healthy Swedish sample, lifetime exposure to violence was associated with some but not all early cardiometabolic risk factors among both males and females. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Funding for data collection was supplied by the Ragnar and Torsten Söderbergs Foundation, AFA Insurance, the Karolinska Institutet and Stockholm County Council Research Funds. This work was also supported by a European Union's Horizon 2020 grant (CoMorMent, grant no: 847776), an ERC Consolidator Grant (StressGene, grant no: 726413) and the Icelandic Equality Fund (grant no. 1233-1232991). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the Regional Ethics Committee in Stockholm (Ref. no. 2018/1152-31/2). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data availability is subject to ethical approval by the Swedish Ethical Review Authority. Applicants must be associated with a university or research institute based in Sweden, see further at